Western Populations Research Articles

Treatment outcomes of non‐curative endoscopic submucosal dissection for superficial gastric neoplasia: A retrospective study at a tertiary care center in the United States

AbstractObjectivesEndoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer; additional treatment may be recommended for patients in whom resection is not curative per the American Society for Gastrointestinal Endoscopy guidelines. The aim of this study was to assess treatment outcomes of ESD for gastric neoplasia, with a focus on cases of non‐curative resection.MethodsThis was a retrospective study of all individuals undergoing ESD for the treatment of gastric adenocarcinoma or dysplasia in a high‐volume tertiary care center in the United States. Data on patient demographic characteristics, clinical history, lesion characteristics, and procedural and clinical outcomes were collected from the electronic medical record.ResultsAmong 82 cases undergoing ESD for the management of gastric neoplasia, 32 cases resulted in non‐curative resection. 20 of these non‐curative cases did not get additional treatment, among which recurrence occurred in two cases with positive horizontal margins only. These patients did not show lymph node metastasis and underwent further endoscopic or surgical resection. There was no recurrence in 11 cases with undifferentiated carcinomas of ≤2 cm in size.ConclusionsAlthough this study was limited by its retrospective design, small sample size, and follow‐up duration, our findings suggest that a risk‐adapted strategy could be employed for certain patients undergoing non‐curative ESD per American Society for Gastrointestinal Endoscopy guidelines, with close follow‐up instead of routine surgery in select cases with favorable features. Further studies are needed to refine the criteria for additional treatment after non‐curative ESD in Western populations.

Biomarkers of polyunsaturated fatty acids and cardiovascular risk factors and events in healthy Asian populations: a systematic review.

The associations between circulating polyunsaturated fatty acids (PUFAs) and cardiovascular risk factors and events in healthy Asian populations have been less examined robustly compared to Western populations. This systematic review aimed to summarise current evidence on the associations between n-3 and n-6 PUFAs biomarkers and cardiovascular risk factors and events in healthy Asian populations. PubMed, Embase, Web of Science and Cochrane Library were searched for observational studies from January 2010 until August 2024. Twenty-three studies were eligible, which covered six Asian countries and included events(n=7), traditional risk factors such as blood pressure and lipids(n=4), physical signs such as arterial stiffness(n=4), non-traditional lipid markers(n=1), markers of inflammation(n=4), markers of thrombosis(n=2), and non-invasive imaging-based markers such as carotid intima media thickness(n=5). Biological sample type included plasma(n=6), serum(n=14) and erythrocyte(n=3). Higher circulating total n-3 PUFAs appeared to be associated with lower hypertension risk and specifically eicosapentaenoic acid and docosahexaenoic acid to be associated with lower myocardial infarction risk, reduction in triglycerides and inflammation. Higher circulating linoleic acid was associated with improved lipid profiles and lower inflammation. Limited evidence led to inconclusive associations between circulating n-6 PUFAs biomarkers and cardiovascular disease events and blood pressure. No consistent associations with arterial stiffness, obesity, thrombosis and imaging-based biomarkers were observed for circulating PUFAs biomarkers in Asian populations. Limited studies exist for each outcome, hence results should be interpreted with caution. More high quality and prospective studies in Asian populations are warranted. Several recommendations such as sample size justification and reporting of non-respondents rate are proposed for future studies.

A CASE OF PARTIAL PROXIMAL AVULSION OF THE RECTUS FEMORIS MANAGED CONSERVATIVELY WITH GOOD FUNCTIONAL OUTCOME

Proximal rectus femoris avulsion is an uncommon injury that is usually seen in athletes, particularly in the Western population. While the existing literature largely focuses on surgical treatment as the main approach, growing evidence suggests that conservative management for these injuries can also be effective. Such injuries are rarely associated with non-sport activities and have not been documented in the Indian population to date. In this report, we present a case of partial proximal avulsion of the rectus femoris that was managed conservatively with a structured rehabilitation programme, leading to good functional outcome.

SCORE2-ASIA risk prediction algorithms: revised models to estimate 10-year risk of cardiovascular disease in the Asia Pacific Region

Abstract Background Most current cardiovascular disease (CVD) prediction tools have been developed and validated solely in Western countries, while there are significant differences between Asian and Western populations in risk factor distributions and CVD incidence patterns. This study outlines the recalibration and validation of the SCORE2-ASIA model to estimate 10-year fatal and non-fatal CVD risk among adults aged 40-69 years with no previous CVD or diabetes in the Asia Pacific Region. Methods The sex-specific and competing risk-adjusted SCORE2 models were systematically recalibrated to reflect CVD incidence in the Asian clinical practice. We defined four risk regions in Asia according to country-specific CVD mortality rates (low risk (<100 CVD deaths per 100,000), moderate risk (100 to <150 CVD deaths per 100,000), high risk (150 to <300 CVD deaths per 100,000), and very high risk (≥300 CVD deaths per 100,000)). Models were recalibrated using region representative data on expected incidences and risk factor distributions, utilising the methodological approaches developed in recalibration of the SCORE2 models for Europe. The SCORE-ASIA model was externally validated in all risk regions using population-based cohort data from independents cohort data. To ensure the European coefficients well applied to Asian populations, the SCORE2 model derivation process was repeated in external validation cohorts. Results Region-specific incidence was estimated using country-specific data on CVD mortality and data on the ratio of fatal to total events on 9,496,212 individuals from 5 Asian countries (496,212 CVD events). For external validation, we analysed data from 12 additional cohorts in 13 Asian countries (4,775,976 individuals, 176,011 CVD events). After applying the derived risk prediction models to external validation cohorts, the pooled external validation C-index was 0.709 (95%CI 0.676-0.743). In the nationally representative CDMD cohort from Singapore (population completely separate from recalibration data) there was adequate agreement between predicted and observed risks. Risk factor coefficients derived in Asian populations were largely similar to the original SCORE2 coefficients, indicating that the original SCORE2 coefficients apply well to the Asian population. Predicted CVD risk varied several-fold across Asian risk regions. For example, the estimated 10-year CVD risk for a 50-year-old non-smoker, with a systolic blood pressure of 140mmHg, total cholesterol of 5.5mmol/L, and HDL-cholesterol of 1.3mmol/L, ranged from 12% for men in low-risk countries to 26% for men in very-high-risk countries, and from 7% for women in low-risk countries to 26% for women in very-high-risk countries. Conclusions The SCORE2-ASIA model accurately predicts 10-year risk of CVD for apparently healthy people in Asian countries after systematic recalibration, thereby enhancing the identification of individuals at higher risk of developing CVD across the Asia Pacific Region.

Prediction of 10-year risk for recurrent atherosclerotic cardiovascular events in a secondary prevention population: Insights from CHART-2 and Suita studies in the Japanese population

Abstract Background Despite the European Society of Cardiology (ESC) guidelines advocating risk prediction models for secondary prevention in established atherosclerotic cardiovascular disease (ASCVD) patients, such models for Japanese individuals remain limited, owing to their comparatively lower ASCVD risk than Western populations. Given this gap, there is a need to develop tailored risk assessment tools for Japanese ASCVD patients to optimize secondary prevention strategies. Purpose Leveraging data from two large-scale, long-term cardiovascular cohorts in Japan, our aim was to develop and externally validate a 10-year risk model predicting recurrent cardiovascular events among patients with established ASCVD. Methods The CHART-2 and Suita studies, large-scale prospective observational multicenter cohort studies in Japan, served as the primary data sources for this investigation. From the CHART-2 study, which comprised 3,560 patients with a history of coronary artery disease or ischemic stroke, we derived our risk model. External validation was conducted using data from the Suita study, which included 445 patients with similar ASCVD backgrounds. The primary outcome of interest was a composite endpoint encompassing cardiovascular death, myocardial infarction, or stroke. Variable selection was performed based on clinically relevant factors previously employed in established risk scores (SMART, REACH, and TRS 2°P risk scores). Logistic regression was utilized for model development, and the predictive performance was assessed using the C-index. Results Over a median follow-up of 10.1 years, the derivation cohort experienced 756 cardiovascular events. Patients in the derivation cohort had an average age of 68.9 ± 10.6 years, with 91% and 24% having a history of coronary artery disease and ischemic stroke, respectively. Using logistic regression, the multivariate model revealed a higher recurrent risk associated with several factors including age, smoking status, systolic blood pressure, diabetes, renal function, number of ASCVD events, atrial fibrillation, lipid levels, left ventricular systolic dysfunction, and statin use. A simple risk score based on these predictors demonstrated a >5-fold gradient of 10-year recurrent risk with a C-index of 0.65 (95% CI 0.63-0.68, Figure). The prediction model was externally validated in the Suita study wit 245 cardiovascular events and a median follow-up of 10.4 years, showing good discriminative ability with a C-index of 0.64 (95% CI 0.60–0.68). Conclusion Our newly developed prediction model offers a valuable tool for identifying individuals at heightened risk of recurrent cardiovascular events over a 10-year period, thereby facilitating more targeted and effective secondary prevention strategies tailored to the unique characteristics of Japanese ASCVD patients.

Treated obstructive sleep apnoea and incident arrhythmias

Abstract Background Obstructive sleep apnoea (OSA) is prevalent in approximately 15% of western populations. Cardiovascular disease and arrhythmia are extremely common in this group with significant morbidity overlap. Whilst treatment of OSA with continuous positive airways pressure (CPAP) appears to reduce hypertension, bradycardia and recurrence of atrial fibrillation (AF), large randomised control trials and meta-analyses do not demonstrate a significant reduction of incident tachyarrhythmias such as atrial fibrillation or sudden cardiac death. Some smaller studies suggest that AF may have up to 20% incidence. Analysis of these studies suggest that there may be significant heterogeneity in both CPAP usage and OSA phenotype, confounding the results. Furthermore, standard arrhythmia detection often underestimates paroxysmal arrhythmias. This on-going trial investigates a treated OSA population using CPAP monitoring and implantable loop recorders (ILR). Purpose This study aims to identify the incidence of arrhythmia in a treated OSA population with comprehensive arrhythmia monitoring and CPAP usage. It also explores the mechanisms linking OSA and arrhythmia such as heart rate variability and turbulence and cardiac biomarkers in order to identify at risk sub populations. Methods Continuous moderate-to-severe OSA patients were recruited from a major UK sleep centre after ECG and medical history confirmed the absence of arrhythmia. Each patient was then randomised to receive either standard-care or standard-care with an ILR with 24-hour heart rate variability/turbulence measurements, echocardiography (where possible) and cardiac biomarkers at baseline and 12 months. All patients had remote CPAP usage monitoring (where possible). The trial ended at 36 months after enrolment. Results 200 patients were recruited to the trial. Current mean average follow-up is 28 months in this on-going trial. Mean age and apnoea hypopnea index at enrolment was 53 years and 43.8 respectively. To date we have diagnosed atrial fibrillation in 15% of the ILR group compared to 2% in the standard care group. Other arrhythmias detected in the ILR group include two with supraventricular tachycardia and 2 with significant pauses but not requiring further treatment. Final analysis of arrhythmia incidence with CPAP usage and heart rate variability/turbulence, and cardiac biomarkers is ongoing with final results due by the time of final submission. Conclusion Arrhythmias, particularly AF, are highly incident in OSA despite CPAP treatment. This study may determine if heterogenous CPAP usage confounds the above observation and whether there may be predictors of arrhythmia that may indicate a need for arrhythmia screening in the OSA population.

Remnant cholesterol and cardiovascular and all-cause mortality in Korean adults

Abstract Background Although previous studies have reported that remnant cholesterol (RC) is associated with cardiovascular disease, studies on RC and various mortality related outcomes including cardiovascular mortality in the general population are scarce and most of them are limited to Western populations. Purpose This study aims to evaluate the effect of RC on mortality related outcomes in a relatively young and middle-aged Korean population. Methods This cohort study included 268,219 subjects (mean age, 38 years and 50.6% men) who were enrolled in the Kangbuk Samsung Health Study between 2003 and 2016. Fasting RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDLC). Results The median RC was 0.47 mmol/L (18 mg/dL) and the prevalence of ≥ 1 mmol/L RC was 11.4%. During the median FU of 6.7 years, high RC (RC ≥ 0.47 mmol/L) significantly increased the risk of multivariable-adjusted cardiovascular mortality compared with low RC (HR[95% CI], 1.43[1.07, 1/93]). Compared with the lowest quintile (RC <0.31 mmol/L), the HRs for cardiovascular mortality were 1.95[0.78, 4.84], 2.47[1.03, 5.91], 2.39[1.00, 5.72], and 2.84[1.19, 6.78] in the second, third, fourth, and highest quintiles, respectively. The HRs for all-cause mortality in the 3rd, 4th, and highest quintiles remained significant (1.24[0.97, 1.59], 1.38[1.08, 1.76], 1.34[1.05, 1/71], and 1.32[1.03, 1.69] in the 2nd, 3rd, 4th, and highest quintiles, respectively). However, there was no significant risk for cancer mortality between RC quintiles. Notably, subgroup analysis showed that individuals with high RC and high hsCRP and high RC and high lipoprotein(a) had a more than twofold and threefold increased risk of cardiovascular mortality, respectively, compared with low RC and low hsCRP and low RC and low lipoprotein(a). Conclusions High RC was significantly associated with increased risk of cardiovascular and all-cause mortality, but not with cancer mortality. In particular, high hsCRP and high lipoprotein(a) weighted the risk association between high RC and cardiovascular mortality.

Prescription time trends in patients with high-impact chronic pain: A National Patient Registry Study.

High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported. We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011-2013, 2014-2016, 2017-2019, and 2020-2022. We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%). In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin). This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

Lefamulin dosing optimization using population pharmacokinetic and pharmacokinetic/pharmacodynamic assessment in Chinese patients with community-acquired bacterial pneumonia

PurposeLefamulin is the first pleuromutilin antibiotic approved for the treatment of community-acquired bacterial pneumonia (CABP). However, the pharmacokinetic/pharmacodynamic (PK/PD) characteristics in Chinese CABP patients are not fully understood. This study aimed to evaluate its microbiological efficacy against Streptococcus pneumoniae and Staphylococcus aureus via PK/PD analysis.MethodsThe population PK (PopPK) model, established with foreign data was validated using data from Chinese CABP patients. PK/PD analysis was conducted for the intravenous administration of 150 mg q12 h for 1-h, 1.5-h and extended 2-h infusion. Oral administrations of 600 mg q12 h were assessed, considering original and higher plasma protein binding.ResultsLefamulin displayed similar PK characteristics in both Chinese and Western populations. The PopPK model effectively predicted lefamulin concentrations in Chinese CABP patients. Under the dosage regimen of 150 mg q12 h via intravenous infusion for 1/1.5/2 h, the probability of target attainments reached 98% at the minimum inhibitory concentration for both 90% S. pneumoniae and S. aureus, considering both original and higher protein binding rates. It is advisable to extend the infusion duration from 1/1.5 h–2 h to minimize the risk of adverse effects at the infusion site. Regardless of fasted or fed conditions, the PTAs for 600 mg q12 h lefamulin via oral administration proved comparable to those for intravenous administration.ConclusionThis study proved that intravenous and oral administrations of lefamulin can reach preclinical PK/PD targets of S. pneumoniae and S. aureus. These findings support the optimal use of lefamulin for the safe and effective treatment of Chinese CABP patients.

Metabolic and lifestyle factors accelerate disease onset and alter gut microbiome in inflammatory non-communicable diseases.

Biomedical and lifestyle factors in Western populations have significantly shifted in recent decades, influencing public health and contributing to the increasing prevalence of non-communicable diseases (NCDs) that share inflammation as common pathology. We investigated the relationship between these factors and 11 NCDs in the cross-sectional FoCus cohort (n = 1220), using logistic regression models. Associations with age-at-disease-onset were specifically analyzed for type 2 diabetes (T2D, low-grade chronic inflammation) and inflammatory bowel disease (IBD, high-grade chronic inflammation) in disease-specific cohorts (FoCus-T2D, n = 514; IBD-KC, n = 1110). Important factors for disease risk were identified using Cox-PH-regression models and time-to-event analysis. We further explored the interaction between identified risk factors and gut microbiome composition using linear models. Lifestyle factors were clearly linked to disease phenotypes, particularly in T2D and IBD. Still, some factors affected only the age-at-onset, but not disease prevalence. High-quality nutrition significantly delayed onset for both IBD and T2D (IBD: HR = 0.81 [0.66; 0.98]; T2D: HR = 0.45 [0.28; 0.72]). Smoking accelerated T2D onset (HR = 1.82 [1.25; 2.65]) but delayed onset in ulcerative colitis (UC: HR = 0.47 [0.28; 0.79]). Higher microbiota diversity delayed IBD onset (Shannon: HR = 0.58 [0.49; 0.71]) but had no effect on T2D. The abundance of specific microbial genera was strongly associated with various biomedical and lifestyle factors in T2D and IBD. In unaffected controls, these effects were smaller or reversed, potentially indicating a greater susceptibility of the gut microbiome to negative influences in T2D and IBD. The dual insights into age-at-disease-onset and gut microbiota composition in disease emphasize the role of certain biomedical and lifestyle factors, e.g., nutrition quality, in disease prevention and management. Understanding these relationships provides a foundation for developing targeted strategies to mitigate the impact of metabolic and inflammatory diseases through lifestyle modifications and gut health management.

A cross-sectional study on distinctive factors associated with conduct behaviors among children presenting with inattention-hyperactivity disorders in Indian context

Abstract Introduction: Conduct behaviors are frequently associated with disorders of inattention and hyperactivity. Many studies have been done in the Western population on predictors of those conduct behaviors among these children with inattention-hyperactivity. However, such studies are lacking in the Indian context. Thus, the current study examined the distinctive factors associated with conduct behaviors among children presenting with inattention-hyperactivity Disorders in the Indian setting. Materials and Methods: A cross-sectional study was done in a Medical College of Kolkata with two groups of children and adolescents each having 50 samples diagnosed as hyperkinetic conduct disorder (HKCD) and hyperkinetic disorder of attention and activity (HKD-AA) as per International Classification of Diseases-10th version. Comparison between the two groups was made with the abbreviated (10-item) Conners’ rating scale for parents (CPRS-HI) and a semi-structured socio-demographic pro forma to find out the distinctive factors associated with HKCD. Results: On comparison between the two groups, significant differences (P < 0.05) were found in items such as male sex, birth complications, inadequate social-skill development, paternal alcohol use disorders (AUD), and disturbed family ambience, which were significantly higher in HKCD. Among CPRS-HI items, impulsivity was the distinguishing feature of HKCD. However, the total severity scores of CPRS-HI were similar in both the groups. In our population, maternal substance abuse was not found, and mood and alcohol use disorders were more common than childhood externalizing disorders in the family history. Conclusion: Similar to the Western population, in our study male sex, birth complications, paternal-AUD, and disturbed family ambience are distinctively higher in conduct behaviors, but contrary to them, there is no maternal substance abuse, and severity of inattention-hyperactivity scores are similar in children with or without conduct behaviors.

Severity levels of anorexia nervosa and atypical anorexia nervosa in a Korean cohort.

Despite its potential for informing tailored treatments, the severity of eating disorders (EDs) lacks clear conceptualisation. The present retrospective cohort study examined the clinical validity and utility of severity specifiers for anorexia nervosa (AN) and atypical AN in a Korean population. Data from 696 Korean outpatients with AN or atypical AN were analysed. Severity criteria for AN from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Medical Emergencies in Eating Disorders (MEED) guidance were used. Severity criteria applied for atypical AN were the frequency of intermittent fasting (ED Diagnostic Scale item 17), Eating Disorder Examination Questionnaire global scores, and the degree of weight suppression. Prevalence of extreme cases of AN in our cohort was higher than in Western populations in previous studies. MEED guidance further subclassified extreme AN, revealing distinct psychopathological profiles across severity levels. The proposed severity classification for atypical AN based on the weight loss behaviour of intermittent fasting showed merit. These findings suggest a potential need for a more nuanced AN severity classification that better represents severe medical aspects and encompasses cultural and ethnic diversities. In atypical AN, there is a need to examine severity indices measuring pathological behaviours.

Phylogeny and systematics of the colubrid snake genera Liopeltis and Gongylosoma (Squamata: Colubridae) and description of a new Himalayan endemic genus and species.

The colubrid snakes of the genera Gongylosoma Fitzinger, 1843 and Liopeltis Fitzinger, 1843 are distributed across south and southeast Asia with five and eight nominate species, respectively. Despite their wide distribution, members of these genera are among some of the least-known colubrids. The two genera were considered synonymous in the past only to be separated later, and are defined on rather nebulose characters with a lack of support from molecular data. To test the monophyly of the two genera, we generated molecular data for the type species of Gongylosoma and species representing the two genera, including samples of Liopeltis rappii (Günther, 1860) from the western Himalayas. Results recovered paraphyly of Liopeltis, especially with regard to the genus Gongylosoma. Morphological data supports recognizing the western and eastern populations of L. rappii as two distinct species. The findings from our integrative taxonomic approach advocate establishing a new genus to embody Liopeltis rappii and a new allied species from the central and western Himalayas. A rediagnosis and revised classification of the genera Gongylosoma and Liopeltis is presented. The results further hint at cryptic diversity across members of the two genera, warranting scrutiny of the most widespread members of the group.

Comparison of Different Prognostic Scoring Systems in Predicting the Severity and Outcome in Alcoholic Hepatitis in Indian Patients

Abstract Introduction: Alcohol abuse causes a variety of liver diseases including alcoholic steatosis, alcoholic hepatitis (AH), liver fibrosis, cirrhosis, and hepatocellular carcinoma. AH is a clinical syndrome which typically occurs after the harmful use of alcohol. There are mild forms that are likely to improve with conservative management, whereas severe cases are associated with a high mortality rate and have a high risk of death despite treatment. The identification of severe AH is important, as this can be associated with 30%–50% short-term mortality. Existing prognostic scores have been validated in the western population, and the data of application in the Indian population are scant. Materials and Methods: It is a prospective observational study conducted for 2 years at Tertiary Care Hospital Army Hospital (Research and Referral) Delhi. The sample size was kept to be 45. For each patient, clinical and laboratory values were obtained on the day of admission and used to calculate the prognostic models according to their formulas. The various scores – Maddrey’s discriminant function (mDF), Glasgow AH score (GAHS), age, bilirubin, international normalized ratio (INR), creatinine score, and model of end-stage liver disease (MELD) including its modification MELD-sodium were calculated. For patients started on steroids, early changes in bilirubin level and Lille score were calculated. Results: All the prognostic scores were found to be good predictors of mortality. When compared with each other, MELD was most indicative of mortality with maximum area under the receiver operating characteristic curve. All the scores were significantly higher in the nonsurvivors than the survivors (P < 0.0001). Conclusion: AH is a clinical syndrome that occurs after the harmful use of alcohol and confers a high mortality. Effective treatment and support for patients with AH is dependent on a proper assessment of the disease severity and estimation of the risk of death as early in the course of the disease as possible.

Infant and Toddler Sleep: The Existing Knowledge Gaps!

Abstract Background: Sleep architecture of infants is vastly different from adults and a significant knowledge gap exists in understanding infant sleep. We aimed to study infant sleep behavior by using validated revised Brief Infant Sleep questionnaire at a tertiary care center in Western Maharashtra. Methodology: We enrolled 65 infants from 1 month to 3 years of age visiting Pediatric OPD between October 2023 to March 2024. We aimed to study infant sleep behavior in a cross section of population at a tertiary care center with a view to find out prevalence of behavioral insomnia of childhood in study population. Results: Around 38.5% children were sleeping less than 5 hours at night and 12.3 % were sleeping only for 6-7 hours. 58.5% children had prolonged sleep onset latency between 30-60 minutes. Around 27.7% children had sleep latency even more than 60 minutes after being put to bed. 70.8% children reported nocturnal awakenings of whom 18.3% reported frequent awakenings. Total sleep duration in our study was 8.592 ± 1.79 hours (Mean ± 2SD). Longest stretch of nocturnal sleep was 5.869 ± 3.72 hours (Mean ± 2SD). Based on the total duration of sleep, prevalence of behavioural insomnia of childhood in our study was 41.5%. The most common associations with behavioural insomnia of childhood were breastfeeding, bottle feeding and rocking but the results were not statistically significant. Conclusion: Prevalence of behavioral insomnia of childhood in India is higher than western population. Indian children have shorter average sleep duration compared to their western counterparts. Bedtime routine needs to be observed regularly to avoid development of behavioral insomnia of childhood which requires strict bedtime rules and consistency.

Aortic root parameter analysis for transcatheter aortic valve implantation in the Pakistani population: a retrospective study

BackgroundTranscatheter aortic valve implantation (TAVI) is a growing treatment for aortic stenosis, but anatomical variations exist across populations. Asians tend to have smaller aortic annuli and higher bicuspid valve morphology compared to Westerners, potentially impacting TAVI valve selection and outcomes. This study analyzes aortic root parameters in Pakistani patients undergoing TAVI.ResultsWe conducted a retrospective analysis of 78 patients who underwent TAVI at the Peshawar Institute of Cardiology from January 2021 to March 2024. Pre-procedural CT scans were analyzed for aortic annulus diameters, area, and other relevant parameters. The mean age was 72.41 years (SD ± 11.99), and 61.5% were male. Aortic annulus diameters (minimum, mean, maximum) were 21.18 mm (SD ± 3.99), 24.21 mm (SD ± 3.93), and 27.49 mm (SD ± 4.43), respectively. Bicuspid aortic valves were present in 34.61% of patients.ConclusionsOur findings suggest that Pakistani patients undergoing TAVI may have aortic root dimensions comparable to Western populations, with a substantial prevalence of bicuspid valves. However, coronary heights were similar to those reported in Asian populations with smaller annuli. Further studies are needed to assess TAVI outcomes in Pakistani patients and determine if tailored valve sizing strategies are required.

Effectiveness of biologic therapies in achieving treatment targets in inflammatory bowel disease; real-world data from the Middle East (ENROLL study).

Real-world data assessing the effectiveness of biologics in patients with inflammatory bowel disease (IBD) in the Middle East are not well-established. In our study, we evaluated the effectiveness of biologic therapies in achieving clinical and endoscopic outcomes in biologic-naïve patients with IBD. A retrospective chart review was conducted at two tertiary care gastroenterology centers using electronic medical records of patients with moderate-to-severe IBD. The study period was from October 2017 to October 2023. Patients who were on infliximab, adalimumab, ustekinumab, or vedolizumab for 12 months were included in the analysis. The primary outcomes were the percentage of IBD-related hospitalizations or surgeries, achieving steroid-free remission, and endoscopic remission. A total of 422 patients were included in the study, of whom 264 (62.5%) patients had Crohn's disease (CD) and 158 (39%) had ulcerative colitis (UC). In patients with CD, endoscopic remission was attained in 51 (52%) of the patients on adalimumab, 38 (53%) of the patients on infliximab, 34 (56%) of the patients on ustekinumab, and 16 (51%) of the patients on vedolizumab. In patients with UC, endoscopic remission was attained in 40 (56%) of the patients on infliximab, 26 (61%) of the patients on adalimumab, 8 (55%) of the patients on ustekinumab, and 11 (53%) of the patients on vedolizumab. adalimumab, infliximab, ustekinumab, and vedolizumab were all effective in achieving clinical and endoscopic clinical outcomes in IBD in both UC and CD. The findings of this study suggest that the efficacy of biologics in a Middle Eastern population is similar to that in a Western population.

Assessment of age specific serum Prostate Specific Antigen (PSA) levels for Indian population: A retrospective analysis at a tertiary healthcare facility.

Prostate-specific antigen (PSA) is a key marker for prostate cancer screening, but its utility is debated, prompting exploration of PSA derivatives for improved accuracy. While racial variations in serum PSA levels are documented, limited data exists for the Indian population. Given increasing life expectancy and heightened awareness of prostate cancer, this study aims to establish age-specific PSA ranges in an Indian cohort, contributing vital insights for population-specific screening and diagnosis. A cross-sectional study was conducted on 4860 men with lower urinary tract symptoms (LUTS). Data, collected from April 2016 to March 2023, included age, PSA levels, digital rectal examination (DRE), and biopsy results. Statistical analysis involved Spearman's correlation, descriptive statistics, and confidence intervals. Of the studied participants, 809 underwent prostatic biopsy, revealing malignancy in 500 cases. Age-specific PSA values were studied in 4170 subjects and showed positive correlation with increasing age and prostate size. Most cancers were metastatic (66%), emphasizing the need for early detection. Age-specific PSA ranges were lower in the Indian population compared to the West. This study's Indian cohort exhibited higher PSA values than some previous Indian studies but lower than Western populations, aligning with global trends. The rising incidence of prostate cancer in India underscores the importance of understanding the disease burden. PSA levels exhibit race-specific variations, cautioning against direct extrapolation of Western data to the Indian population. This study contributes age-specific PSA ranges for an Indian cohort, facilitating nuanced prostate cancer screening strategies.

Uncovering novel pathogenic variants and pathway mutations in triple-negative breast cancer among the endogamous mizo tribe.

The incidence of triple-negative breast cancer (TNBC) in India is higher compared to Western populations. The objective of this study is to identify novel and less reported variants in TNBC in Mizoram, a state with a high cancer incidence in India. We analysed whole exome sequencing data from triple-negative breast cancer (TNBC) patients in the Mizo population to identify key and novel variants. Moreover, we analysed reported breast cancer-related genes and pathway alterations. Somatic mutation analysis revealed that TP53 was the most frequently mutated gene and TP53, CACNA1E, IGSF3, RYR1, and FAM155A as significantly mutated driver genes. Based on the ACMG guidelines, we identified a rare pathogenic germline variant of BRCA1 (p.C1697R) in 13% and a likely pathogenic frameshift insertion in RBMX (p.P106Ffs) in 73% of the patients. We also found that the ATM, STK11, and CDKN2A genes were significantly mutated in germline TNBC samples compared to healthy samples. Moreover, we identified novel somatic variants in CHEK2 (p.K182M) and NF1 (p.C245X), and novel germline variants RB1 (p.D111G), CDH1 (p.A10Gfs), CDKN2A (p.V96G), CDKN2A (p.S12Afs*22), MAP3K1 (CAAdelins0), MSH6 (p.L1226_L1230del), and PMS2 (TTCdelins0). Pathway analysis revealed that most somatic mutations were highly associated with PI3K-Akt signalling pathway and MAPK signalling pathways in TNBC. These findings identified novel variants and key genes contributing to disease development and progression. Further analysis of less studied genes, including RBMX, MRC1, ATM, CTNNB1, and CDKN2A, in TNBC may reveal new potential genes for targeted therapeutic strategies and contribute to clinical advancements in the treatment of TNBC.

Sleep quality and emotional eating in college students: a moderated mediation model of depression and physical activity levels

BackgroundEmotional eating is a prevalent maladaptive coping mechanism among college students, which is associated with mental health and sleep concerns. Though previous studies have established a link between sleep quality, depression and emotional eating, most of these have been in Western populations. In addition, few existing studies have taken physical activities into account, and the underlying mechanisms between these four variables remain to be further studied. Therefore, our study investigated the mediating role of depression and the moderating role of physical activity levels in the relationship between sleep quality and emotional eating among Chinese college students. Our study can help to understand the characteristics of this population and provide guidance on the intervention pathways for emotional eating.MethodsA convenience sampling method was employed to select eligible participants for investigation. The General Information Questionnaire, the Pittsburgh Sleep Quality Index Scale, the Patient Health Questionnaire, the Dutch Eating Behavior Scale, and the International Physical Activity Questionnaire were employed to measure the general condition, sleep quality, depression, emotional eating, and physical activity. A total of 813 college students (Mage = 19.14, SD = 1.12, range = 17 ~ 25 years old, 71.1% females) completed the survey. The moderated mediation analysis was carried out using the SPSS PROCESS macro.ResultsAfter controlling for sex, age, and body mass index (BMI), sleep quality positively predicted emotional eating. Depression primarily mediated the association between them. Besides, physical activity levels moderated the relationship between sleep quality and emotional eating via depression. Depression significantly predicted emotional eating among students with low levels of physical activity; however, it was not significant among students with moderate or high levels of physical activity.ConclusionsThe role of depression mediates the link between sleep quality and emotional eating. Regular exercise can ease the symptoms of emotional eating through depression. This implies the importance of offering more sleep hygiene education and physical activity in university settings.